HBA1c检测在妊娠糖尿病筛查诊断中的价值

HBA1c values of detection in the diagnosis of gestational diabetes screening

目的探讨糖化血红蛋白（HBAlc）检测在妊娠糖尿病（GDM）筛查诊断中的价值，为临床更好地应用HBAlc提供参考。方法选取2012年1月-2013年6月在新疆乌鲁木齐市妇幼保健院同时进行空腹血糖（FPG）、75g口服葡萄糖耐量试验（OGTT）和HBAIc检测的24-28w孕妇541例为研究对象。依照美国糖尿病学会（American Diabetes Association，ADA）新的GDM诊断标准，将研究对象分为GDM组（267例）和对照组（274例），通过受试者工作特征（ROC）曲线评价空腹血糖（FPG）、糖化血红蛋白（HBAlc）在GDM筛查诊断中的应用价值；初步确定合适的HBAlc筛查GDM的切点；对FPG、HBAlc进行方法学评价，比较其诊断效率。结果HBAlc、FPG筛查GDM的ROC曲线下面积（AUC）分别为0．901、0．819，HBAlC的诊断具有较高的准确性。HBAlc的检测灵敏度（94．4％）明显高于FPG（61．0％），并且HBAlc的漏诊率（5．6％）明显低于FPG的漏诊率（39．0％），HBAlc比FPG更适用于筛查GDM。取HBAlC为5．45％作为筛查的界值更合适。结论HBAlc筛查GDM的AUC〉0，9有较高的准确性。选择5．45％作为cut-off值的诊断效率较高，在筛查GDM中具有-定的临床价值。HBAlc可作为较FPG更有效的-项筛查诊断GDM的指标。

Objective To study the value of the glycosylated hemoglobin （HBAlc） in the diagnosis of gestational diabetes mellitus （GDM）, to provide the reference for clinical application of HBAlc. Methods 541 cases of pregnants between 24 to 28 weeks were selected between January 2012 and June 2013 in Maternity hospital maternity and children＇s health care centers of Xinjiang uygur autonomous region of Urumqi. We tested the fasting plasma glucose （FPG）, 75g oral glucose tolerance test （OGTT） and HBAlc for them. Based on the latest GDM diagnosis standard of American Diabetes association（ADA）, the samples were divided into the GDM group （267 cases） and the control group （274 cases）, evaluating the diagnosis value of FPG, HBAlc in GDM by the receiver-operating characteristic （ROC） ; Ensuring preliminary the tangent point for GDM by screening HBAlc; evaluating the FPG and HBAlc, and comparing the efficiency of diagnostic. Results The AUC of HBA1C, fasting plasma glucose （FPG） were 0.901, 0.819,which turned out to be a high accuracy. The detection sensitivity （94.4%） of HBAIc was significantly higher than those of FPG （61.0%）, and HBAlc missed diagnosis rate was 5.6~, far below the FPG of missed diagnosis （39.0%）, which approved that HBAlc was more suitable for screening for GDM than FPG. Take HBAlc 5.45% as the boundary value of the screening is more suitable. Conclusion AUC of GDM which was higher than 0.9 turned out to be a great accuracy. Taking 5.45% as the cut-off value was more appropriate, the diagnosis efficiency was higher, which had certain clinical value in screening for GDM. HBAlc screening for GDM could be taken as a standard for GDM compared with missed diagnosis FPD.